Roaring Fork Surgical Associates Prof LLC

Primary specialty

Surgery PhysicianTaxonomy code 208600000X

License

80.05611.1 Issued in CO

Legal business name

ROARING FORK SURGICAL ASSOCIATES PROF LLC

Practice address

1906 Blake Ave
Glenwood Springs, CO 81601-4227

Phone

(970) 945-6533

Fax

(970) 945-3945

NPI assigned

Jan 8, 2007

Last updated

Feb 21, 2018By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Brad Nichol, MDNPI 1912065756

Title

General Surgeon

Phone

(970) 945-6533

Specialties & licenses 2

Addresses

Other identifiers 3

Medicare fee-for-service enrollment

Enrolled in CO

Enrollment records 1

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Brad Nichol, MD

  • Surgery Physician
  • Glenwood Springs, CO
  • NPI 1912065756
  Medicare reassignment Authorized official
• Randall E Ross, MD

  • Surgery Physician
  • Glenwood Springs, CO
  • NPI 1427116698
  Medicare reassignment

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1168214400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1519171200000",
    "number": "1447308465",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1906 BLAKE AVE",
            "city": "GLENWOOD SPRINGS",
            "state": "CO",
            "postal_code": "816014227",
            "telephone_number": "970-945-6533",
            "fax_number": "970-945-3945"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1906 BLAKE AVE",
            "city": "GLENWOOD SPRINGS",
            "state": "CO",
            "postal_code": "816014227",
            "telephone_number": "970-945-6533",
            "fax_number": "970-945-3945"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ROARING FORK SURGICAL ASSOCIATES PROF LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-08",
        "last_updated": "2018-02-21",
        "status": "A",
        "authorized_official_last_name": "NICHOL",
        "authorized_official_first_name": "BRAD",
        "authorized_official_title_or_position": "GENERAL SURGEON",
        "authorized_official_telephone_number": "970-945-6533",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "CO",
            "license": "80.05611.1",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RR MEDICARE",
            "identifier": "CG 5876",
            "state": "CO"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "607484",
            "state": "CO"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "04020459",
            "state": "CO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• McKenzie Alison Rieder, CPNP
• Sarah Kathleen Rieves, M.D.
• River Bridge Regional Center Inc.
• Roaring Fork Hospice
• Roaring Fork Rehab & Performance LLC
• Robert Adams Orthopaedics, PC
• Katharine Roberts
• Dillon Robinson
• Rocky Mountain Audiology LLC
• Rocky Mountain Healing Art Inc

• Surgery Physician in Glenwood Springs, CO
• Providers in Glenwood Springs, CO by specialty
• Surgery Physician in Colorado

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 21, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.